Thursday, August 13, 2009

Gynecologists versus IVF specialists

Many gynecologists are critical of IVF specialists. They feel that they advise IVF for practically all the infertile couples who come to them, and end up overtreating many couples who could have got pregnant with much simpler treatment, just to make more money.

I think there is some truth in this crticism. A man with a hammer tends to see only nails; and some IVF doctors do overtreat infertile couples.

I just saw an example today, and hence this post. This was a young 29 year old woman who had been trying to have a baby for just 6 months. She went to her gynecologist who tried to reassure her; and told her to get ovulation scans done to document that she was ovulating.

The scans confirmed that she did ovulate from the right ovary - but the ultrasonographer also noted that the left ovary was "small".

She was worried that this meant that her egg quality was poor, which is why she met a leading IVF specialist. This doctor did an ultrasound scan in her office ; told her that her ovaries were "small" - and then advised her to do IVF, without telling her what her antral follicle count was or what her ovarian volume was. There was absolutely no documentation - she did not even provide an image of her scan or bother to test her AMH levels or FSH levels to confirm this diagnosis.

She came to me for a second opinion, and I had to spend 30 min trying to reassure her that this was half-baked advise.

Infertile couples are emotionally vulnerable - and it's easy to play on their feelings and prey on them. Many small abnormalities are highlighted - and simple anatomic variants of no clinical importance are treated as "diseases" which need to be treated !

While this is the kind of patient who will contribute to the IVF clinic's success rates and bottom line ( because she never needed IVF in the first place), overtreating infertile couples will give all IVF specialists a bad reputation.Patients need to learn to protect themselves by doing their own homework and ensuring that they are not being taken for a ride !